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Pancreatic ductal adenocarcinoma remains an aggressive cancer with a low 5-year survival rate. Although gemcitabine has been a standard treatment for advanced pancreatic cancer, patients often develop resistance to this therapeutic. We have previously shown that treating pancreatic cancer cells in vitro with a combination of gemcitabine and the cytokine TRAIL significantly reduced both cell viability and survival. The data presented here demonstrate that this response to treatment is inhibited when cells are incubated with a conditioned medium derived from untreated cells. We show that this inhibition is specifically mediated by extracellular vesicles present in the conditioned medium, as seen by a significant decrease in apoptosis. Additionally, we further demonstrate that this effect can be reversed in the presence of GW4869, an inhibitor of exosome biogenesis and release. These results show that pancreatic cancer cell-derived extracellular vesicles can confer resistance to treatment with gemcitabine and TRAIL. The implications of these findings suggest that removal of EVs during treatment can improve the response of cells to gemcitabine and TRAIL treatment in vitro.

IntroductionNon-communicable diseases (NCDs) and their effects are rising quickly. NCDs such as cardiovascular illnesses, diabetes, cancer, and chronic lung diseases cause 60% of global deaths; of which, 80% occur in developing countries. In established health systems, primary healthcare handles most of the NCD care.MethodologyThis is a mixed-method study conducted to analyze the health service availability and readiness toward NCDs using the SARA tool. It included 25 basic health units (BHUs) of Punjab, which were selected through random sampling. Quantitative data were collected using the SARA tools, while qualitative data were collected through in-depth interviews with healthcare providers working at the BHUs.ResultsThere was a problem of load shedding of both electricity and water in 52% of the BHUs, which leads to the poor availability of healthcare services. Only eight (32%) out of 25 BHUs provide the diagnosis or management of NCDs. The service availability was the highest for diabetes mellitus (72%), followed by cardiovascular disease (52%) and then chronic respiratory disease (40%). No services were available for cancer at the BHU level.ConclusionThis study raises issues and questions about the primary healthcare system in Punjab in two areas: first, the overall performance system, and second, the readiness of basic healthcare institutions to treat NCDs. The data show that there are many persisting primary healthcare (PHC) deficiencies. The study found a major training and resource deficit (guidelines and promotional materials). Therefore, it is important to include NCD prevention and control training in district training activities. NCDs are underrecognized in primary healthcare (PHC).

Adolescence is a transitional period of physical and mental development that develops between childhood and adulthood. This change includes biological, social, and psychological changes. The study has tried to establish the need for adolescent health services in Pakistan. The study was designed to determine perspective of adolescents regarding need of Adolescents health services and to advocate students, parents and peers about the needs of adolescents. The study has theoretical and practical significance. A Mixed method study was conducted at the Department of Public Health, Armed Forces Post Graduate Medical Institute, National University Medical Sciences Rawalpindi from March 2022 to May 2022 by combining quantitative and qualitative research method. The data collection and analysis has followed the survey research type protocol and descriptive research methodology. Students of 1st year and 2nd year were the study population. The sample size was 380 and the duration of study was based on 2 months. Simple Random Sampling technique was used in Quantitative research method, while the focus group discussion was done with 8-10 participants. The quantitative data collection was done through closed ended questionnaire and qualitative data collection was done through open ended structured interview guide. The quantitative data was analysed statistically on SPSS and qualitative data was analysed through thematic content analysis. This study has found that regarding the knowledge about puberty and bodily changes, there were mixed opinions of the participants and adolescents have no standardized prior knowledge of bodily changes and personal hygiene to a satisfactory level. It was found that their source of guidance, was internet, friends and their close circles which is ambiguous to some extent. The study found that adolescents do not face severe anxiety or depression and other emotional complexities but they face frustration and hindrance because of lack of background knowledge. It was also found that the participants were inclined to share their experiences with their mothers, friends, relatives and their sisters. It found that the majority of the participants have not smoked or run away from home. The study also found that there is a need of adolescent health services in Pakistan. Keywords: adolescent health services, Rawalpindi